Temporal Trends in Percutaneous Coronary Intervention–Associated Acute Cerebrovascular Accident (from the 1998 to 2008 Nationwide Inpatient Sample Database)

Acute cerebrovascular accident (CVA) after percutaneous coronary intervention (PCI) for acute coronary syndrome and coronary artery disease is associated with high rates of morbidity and mortality. Nationwide Inpatient Sample from 1998 to 2008 was used to identify 1,552,602 PCIs performed for acute coronary syndrome and coronary artery disease. We assessed temporal trends in the incidence, predictors, and prognostic impact of CVA in a broad range of patients undergoing PCI. The overall incidence of CVA was 0.56% (95% confidence interval [CI] 0.55 to 0.57). The incidence of CVA remained unchanged over the study period (adjusted p for trend = 0.2271). The overall mortality rate in the CVA group was 10.76% (95% CI 10.1 to 11.4). The adjusted odds ratio (OR) of CVA for in-hospital mortality was 7.74 (95% CI 7.00 to 8.57, p <0.0001); this remained high but decreased over the study period (adjusted p for trend <0.0001). Independent predictors of CVA included older age (OR 1.03, 95% CI 1.02 to 1.03, p <0.0001), disorder of lipid metabolism (OR 1.31, 95% CI 1.24 to 1.38, p <0.001), history of tobacco use (OR 1.21, 95% CI 1.10 to 1.34, p = 0.0002), coronary atherosclerosis (OR 1.56, 95% CI 1.43 to 1.71, p <0.0001), and intra-aortic balloon pump use (OR 1.39, 95% CI 1.09 to 1.77, p = 0.0073). A nomogram for predicting the probability of CVA achieved a concordance index of 0.73 and was well calibrated. In conclusion, the incidence of CVA associated with PCI has remained unchanged from 1998 to 2008 in face of improved equipment, techniques, and adjunctive pharmacology. The risk of CVA-associated in-hospital mortality is high; however, this risk has decreased over the study period.